How Long Do Medicare Enrollees Wait to See a Doctor?

A survey of beneficiaries enrolled in both original Medicare and Medicare Advantage (MA) plans revealed a common problem: More than a third of those polled had to wait a month or more to get in to see a doctor. And Advantage enrollees are more likely than original Medicare beneficiaries to face delays getting care because the health plan had to approve the service ahead of time.

Despite the wait-time issue, more than two-thirds of beneficiaries — whether enrolled in original Medicare or an MA plan — say the health care program for older Americans and people with disabilities is fully meeting their expectations, according to a new report from the Commonwealth Fund, a nonpartisan think tank.

Commonwealth conducted the survey between Nov. 6. and Jan. 4. It commissioned a nationally representative telephone and online sample of 3,280 Medicare beneficiaries who were asked about the value of their care, measuring such factors as access to benefits, services, providers, whether their care was coordinated and how satisfied they were. There were 1,946 survey respondents in Medicare Advantage and 1,334 respondents in traditional Medicare.

AARP Membership— $12 for your first year when you sign up for Automatic Renewal

Get instant access to members-only products and hundreds of discounts, a free second membership, and a subscription to AARP the Magazine.

Join Now

Wait times can be long

“This isn’t the first data to show that many people on Medicare have to wait over a month to see a physician,” says Gretchen Jacobson, vice president for Medicare at Commonwealth and lead author of the report. “It is very concerning and it’s very interesting that people are having similar experiences in Medicare Advantage and traditional Medicare with this.”

Thirty-six percent of survey respondents who were enrolled in an Advantage plan said that within the past two years they had waited more than a month to see a doctor, while 34 percent of original Medicare enrollees had such a wait. 

What the survey does not say, Jacobson cautions, is whether people are having to wait more than a month to see a doctor for an urgent problem or for more routine care.

“CMS is committed to ensuring that people with Medicare Advantage and traditional Medicare have timely access to medically necessary care and we appreciate the stakeholders’ and the public’s feedback to our programs,” Meena Seshamani, M.D., director of the federal Centers for Medicare & Medicaid Services (CMS), says in an emailed statement.

Agency regulations for Medicare Advantage plans set wait-time standards for primary and behavioral health care. They say that enrollees should get care immediately for urgently needed or emergency services; within seven business days for care that isn’t an emergency but something for which an enrollee needs medication attention; and within 30 days for routine and preventive care. CMS officials have not said whether these standards also apply to providers who treat enrollees in original Medicare and how the wait-time standards are enforced.